CareMetx, LLC’s OutcomeRx Launches a Reinsurance Product for Cell and Gene Therapies

OutcomeRx, a division of CareMetx, LLC, has launched a reinsurance product to provide coverage access to high-cost specialty drugs, including therapies in the emerging cell and gene therapy market. 

One way that insurers can reduce their overall risk and provide protection against excessive claims is to work with reinsurers. In exchange for a fee, reinsurers will accept the risk ceded to them by the insurer. Reinsurance is insurance for insurance companies.

CareMetx, LLC is a hub services company known for its analytics approach to patient engagement. CareMetx started a new division in 2019, OutcomeRx, to focus exclusively on engaging with biotech companies to think through, structure, and manage value-based agreements.

CareMetx, LLC has five offices and operates as a national patient access company offering turn-key solutions, proprietary e-services and collaborative patient support programs.

OutcomeRx, in conjunction with its partners, develops and markets financial, reinsurance, and warranty products that address the efficacy and actuarial risk associated with specialty therapies including Cell and Gene Therapies, while lowering the access and affordability burden on patients and their families.

The Patient Access to Costly and Curative Therapies (PACCT) carve-out reinsurance product provides first-dollar coverage related to three costly therapies: Spinraza and Zolgensma for spinal muscular atrophy and Luxturna for Leber Congenital Amaurosis (LCA)—an inherited retinal disorder. It will be available with a coverage effective date of January 1, 2021.

The first-dollar coverage reinsurance product provides payers coverage without deductibles for these therapies, which is intended to reduce the cost burden on patients with SMA and LCA. 

OutcomeRx has partnered with Crum & Forster Accident and Health and IronHealth, a division of Ironshore, to bring the reinsurance carve-out to pharmacy benefit managers, health plans, employer groups and benefit administrators. 


Takeaway: CareMetx, LLC is taking a leading role in providing coverage access to high-cost specialty drugs including therapies in the growing emerging cell and gene therapy market